| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,855 |
8,983 |
$1.50M |
| D0140 |
Limited oral evaluation - problem focused |
14,934 |
14,025 |
$1.10M |
| D1110 |
Prophylaxis - adult |
11,111 |
11,070 |
$951K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,133 |
8,098 |
$517K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,492 |
3,035 |
$477K |
| D0120 |
Periodic oral evaluation - established patient |
16,725 |
16,684 |
$464K |
| D1351 |
Sealant - per tooth |
18,708 |
5,440 |
$435K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,910 |
3,290 |
$413K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,580 |
1,889 |
$362K |
| D1120 |
Prophylaxis - child |
9,310 |
9,299 |
$356K |
| D1206 |
Topical application of fluoride varnish |
20,441 |
20,391 |
$299K |
| D0274 |
Bitewings - four radiographic images |
7,016 |
6,988 |
$169K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,539 |
1,291 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
16,187 |
15,688 |
$161K |
| D0210 |
Intraoral - complete series of radiographic images |
3,565 |
3,445 |
$149K |
| D0272 |
Bitewings - two radiographic images |
6,633 |
6,623 |
$140K |
| D2331 |
|
869 |
745 |
$106K |
| D2140 |
|
1,259 |
1,030 |
$99K |
| D1354 |
|
5,290 |
2,587 |
$96K |
| D2330 |
|
990 |
811 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
424 |
$73K |
| D5110 |
|
57 |
57 |
$56K |
| D0330 |
Panoramic radiographic image |
1,605 |
1,597 |
$54K |
| D0270 |
|
7,324 |
7,223 |
$49K |
| D2335 |
|
309 |
252 |
$47K |
| D4355 |
|
359 |
355 |
$45K |
| D2940 |
|
366 |
336 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,331 |
3,895 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,056 |
1,053 |
$31K |
| D2160 |
|
237 |
223 |
$31K |
| D2332 |
|
169 |
149 |
$23K |
| D4341 |
|
128 |
69 |
$20K |
| D4346 |
|
128 |
128 |
$11K |
| D5120 |
|
17 |
17 |
$3K |
| D1352 |
|
61 |
44 |
$2K |
| D0191 |
|
125 |
121 |
$1K |
| D1320 |
|
1,230 |
1,188 |
$548.80 |
| D0603 |
|
10,557 |
10,437 |
$525.43 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
35 |
$504.00 |
| D0601 |
|
1,178 |
1,168 |
$86.44 |
| D0602 |
|
3,154 |
3,147 |
$43.31 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,609 |
1,535 |
$0.00 |
| D1353 |
|
551 |
212 |
$0.00 |